Highlights

Macrosomia and maternal adiposity

Among pregnant women without gestational diabetes, mothers whose infants are large for gestational age are more likely to have a higher body mass index before pregnancy, greater weight gain during pregnancy and lower levels of leptin. Retnakaran and colleagues analyzed data for 472 pregnant women in their cohort study who underwent an oral glucose tolerance test late in pregnancy. Targeting healthy body weight in young women is a strategy to reduce the risk of infant macrosomia, say the authors. See Research, page 1353

New criteria have been proposed for the diagnosis of gestational diabetes that will increase the incidence to nearly 1 in 5 pregnancies. Because these changes in diagnostic criteria carry widespread implications for practice and health care funding, more general debate is needed before their acceptance. See Commentary, page 1341

Thiazolidinediones and bladder cancer

Adults with type 2 diabetes mellitus who use thiazolidinediones are at increased risk of bladder cancer. This finding comes from a meta-analysis of 4 randomized controlled trials and 6 observational studies. The risk was observed specifically with pioglitazone, whereas the findings were inconclusive regarding rosiglitazone. These results may help inform clinical decision-making, because other treatment options exist that are not associated with cancer, say the authors. See Research, page E675

Mental health crises in children

First Nations adolescents and adolescents from families receiving low-income subsidies made more visits to the emergency department for mental health crises than did children from families that did not receive subsidies. This study used routine health care data to count emergency visits and follow-up visits and to classify possible explanatory factors. Findings from this study could help improve discharge planning, say Newton and colleagues. See Research, page E665

Alpha-1 antitrypsin deficiency

About 5% of people with chronic obstructive pulmonary disease are thought to have alpha-1 antitrypsin deficiency, yet only 4%–5% of those have been identified. Why is it important to identify this deficiency? Brode and colleagues say that newer therapies may prevent further lung destruction and stabilize the disease. These patients are also at risk of liver disease and require monitoring. See Review, page 1365

Physical punishment of children

With the growing body of research, physicians can now confidently encourage parents to adopt constructive approaches to disciplining children. According to Durrant and Ensom, numerous studies have found that physical punishment increases the risk of broad and enduring negative developmental outcomes, including mental health disorders and slower cognitive development. Effective discipline depends on clear, age-appropriate expectations, effective communication and a safe environment. See Analysis, page 1373

Clostridium difficile infection

A 66-year-old woman has diarrhea after receiving levofloxacin for pneumonia. Her stool tests positive for Clostridium difficile toxin. Kandel and colleagues review the next steps in managing C. difficile infection, including treatment, monitoring and prevention of recurrence. See Practice, page 1383

Family history and breast cancer

Obtaining a careful family history is central to identifying potential carriers of BRCA mutations who should be offered genetic counselling. Clinical interventions for carriers can substantially reduce the risk of breast or ovarian cancer, say Carroll and colleagues. See Practice, page 1391

Charcot foot

Lack of sensation can result in the development of Charcot foot or neuropathic arthropathy in up to 7.5% of those with diabetic neuropathy. Characterized by pathologic fractures, dislocations or subluxations that distort the foot’s architecture, this condition requires prompt immobilization, absolute non–weight bearing and professional foot care. Some may require surgery. See Practice, page 1392